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Methotrexate
Immunosuppressive drugs are used to control
over-activity of the immune system in patients
with rheumatoid
arthritis, systemic lupus erythematosus,
myositis and other rheumatic conditions. Commonly
used medications are methotrexate, azathioprine
and cyclophosphamide. These medications are
potent and may have serious side effects.
Consult your doctor if you have further questions
or if early warning signs develop while you
are taking this medication.
The usual dose of methotrexate is from 5
to 25 milligrams once a week, given as tablets
or an injection. Tablets of folic acid (also
called folate) are often given with methotrexate
to reduce the risk of some side effects. The
beneficial effects of methotrexate begin after
4 to 6 weeks. The full beneficial effects
of methotrexate are seen after 6 months of
treatment.
|
| Side
Effect |
Warning
Signs |
To
reduce this side effect |
| mouth ulcers* |
|
|
| nausea, vomiting, abdominal pain, diarrhoea* |
|
|
| rash* |
|
|
| low blood counts* |
easy bruising/bleeding, infection |
|
| liver scarring |
|
avoid ALL alcohol beer, whiskey, etc.)
tell your doctor if you previously had yellow
eyes (jaundice), liver inflammation (hepatitis)
or if any member of your family had hepatitis |
| lung inflammation |
persistent breathlessness or cough |
stop smoking |
| infections, especially shingles |
fever |
|
|
(*usually
returns to normal when the medication dose is
reduced or stopped)
Monitoring:
Regular blood tests are essential to detect
low blood counts or liver inflammation in the
early stages. A chest X ray is often done before
starting methotrexate, as well as and tests
for hepatitis B and C in selected patients.
Foods/Medications to
Avoid: Nil
Important:
Methotrexate can cause miscarriage or birth
defects. Female patients should NOT become pregnant
while taking methotrexate and must use reliable
contraceptive measures to prevent this. Male
patients should wait three months after stopping
methotrexate before having children as it can
affect the quality and/or amount of sperm.
While taking methotrexate,
regular blood tests are essential to for early
detection of side effects to prevent or reduce
damage to major organs.
Certain vaccinations/ immunisations
should not be given while taking methotrexate.
If you are planning to have vaccinations, check
with your doctor.
If you
are unwilling to have regular blood tests or
to use reliable contraception, your doctor may
have to stop treating you with methotrexate.
Azathioprine
(Imuran)
Immunosuppressive drugs are
used to control over-activity of the immune
system in patients with rheumatoid
arthritis, systemic lupus erythematosus,
myositis and other rheumatic conditions. Commonly
used medications are methotrexate, azathioprine
and cyclophosphamide. These medications are
potent and may have serious side effects. Consult
your doctor if you have further questions or
if early warning signs develop while you are
taking this medication.
Azathioprine tablets are given
in a dose of 25 to 150 milligrams a day. The
beneficial effects of azathioprine begin after
4 to 6 weeks and the full benefits of treatment
are seen after taking azathioprine for 3 to
4 months. |
| Side
Effect |
Warning
Signs |
To
reduce this side effect |
| mouth ulcers* |
|
|
| nausea, vomiting, abdominal pain, diarrhoea* |
|
|
| rash* |
|
|
| low blood counts* |
easy bruising/bleeding, infection |
|
| liver or pancreas inflammation* |
yellow eyes, tea coloured urine or constant
abdominal pain |
avoid ALL alcohol beer, whiskey, etc.)
tell your doctor if you previously had yellow
eyes (jaundice), liver inflammation (hepatitis)
or if any member of your family had hepatitis |
| infections |
fever |
|
|
(*usually
returns to normal when the medication dose is
reduced or stopped)
Monitoring:
Regular blood tests are essential to detect
low blood counts and liver inflammation in the
early stages.
Foods/Medications to
Avoid: Allopurinol (Zyloric), a medication
to treat gout, should NOT be taken if you are
being treated with Azathioprine.
Important:
Azathioprine may cause miscarriage or birth
defects. Female patients should generally not
become pregnant while taking azathioprine (there
are rare exceptions to this guideline) and must
use reliable contraceptive measures to prevent
this. Male patients should wait three months
after stopping azathioprine before having children
as it can affect the quality and/or amount of
sperm.
While taking azathioprine,
regular blood tests are essential to for early
detection of side effects to prevent or reduce
damage to major organs.
Certain vaccinations/ immunisations
should not be given while taking azathioprine.
If you are planning to have vaccinations, check
with your doctor.
If you
are unwilling to have regular blood tests or
to use reliable contraception, your doctor may
have to stop treating you with azathioprine.
Cyclophosphamide
(Endoxan, Cytoxan)
Immunosuppressive drugs are
used to control over-activity of the immune
system in patients with rheumatoid
arthritis, systemic lupus erythematosus,
myositis and other rheumatic conditions. Commonly
used medications are methotrexate, azathioprine
and cyclophosphamide. These medications are
potent and may have serious side effects. Consult
your doctor if you have further questions or
if early warning signs develop while you are
taking this medication.
Cyclophosphamide can be given
as a tablet (25 to 150 milligrams per day) or
as a monthly injection. |
| Side
Effect |
Warning
Signs |
To
reduce this side effect |
| mouth ulcers* |
|
|
| nausea, vomiting, abdominal pain, diarrhoea* |
|
|
| loss of hair* |
|
|
| rash* |
|
|
| low blood counts* |
easy bruising/bleeding, infection |
|
| infections |
fever |
|
| bladder inflammation* |
smoky or reddish urine or painful urination |
drink extra water (ask your doctor how
much water you can drink a day) |
| lung scarring |
persistent breathlessness or cough |
stop smoking |
| low sperm counts |
|
|
| temporary or permanent cessation of menstrual
periods |
|
|
| cancer of the bladder or blood |
smoky or reddish urine, weight loss, swelling
of the lymph glands |
|
|
(*usually
returns to normal when the medication dose is
reduced or stopped)
Monitoring: Regular blood
and urine tests
Foods/Medications to Avoid:
Nil
Important:
Cyclophosphamide can cause miscarriage or birth
defects. Female patients should NOT become pregnant
while taking these medications and must use
reliable contraceptive measures to prevent this.
Male patients should wait three months after
stopping cyclophosphamide before having children
as it can affect the quality and/or amount of
sperm.
While taking cyclophosphamide,
regular blood tests are essential for early
detection of side effects to prevent or reduce
damage to major organs.
Certain vaccinations/ immunisations
should not be given while taking cyclophosphamide.
If you are planning to have vaccinations, check
with your doctor.
If you
are unwilling to have regular blood tests or
to use reliable contraception, your doctor may
have to stop treating you with cyclophosphamide.
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